September 2016
Welcome to the ebulletin Welcome to the Public Health Network Cymru September e-bulletin. This month the e-bulletin spotlights on oral health which as you will see raises health concerns for all age groups although tooth decay is the commonest chronic disease affecting children. We have included some of the research going on in Wales along with details of current oral health projects for children as well as the older population. Those of you who have visited the website recently will see that the homepage has had a makeover. It is now even more interactive with the most recent news, events and consultations available to view immediately. However don’t forget to logon to the website to view your own personalised homepage. We are in the process of organising our latest seminar on Planning, Physical Activity and Health which will take place on the 30 November 2016 and our conference which will focus on Adverse Childhood Experiences taking place on the 15 March 2017. If you have any news or events that you would like included in the next e-bulletin please email us via publichealth.network@wales.nhs.uk.
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Smile lik
ke you mean it Spotlight on Oral Health This month’s e-bulletin focuses on oral health. Oral health is essential to general health and quality of life. It is a state of being free from mouth and facial pain, oral and throat cancer, oral infection and sores, periodontal (gum) disease, tooth decay, tooth loss, and other diseases and disorders that limit an individual’s capacity in biting, chewing, smiling, speaking, and psychosocial wellbeing. (World Health Organisation, 2012)
Something To Smile About
By Nigel Monaghan, Consultant in Dental Public Health, Public Health Wales Tooth decay is the commonest chronic disease affecting children, causing pain and ruining smiles. Children in deprived communities are more commonly to experience tooth decay as they are more likely to have sugary food and drink frequently. Getting teeth into contact with fluoride can help. In 2008 48% of 5 year old children in Wales had at least 1 tooth with obvious dental decay. In the same year the Welsh Government launched Designed to Smile to improve the oral health of children in deprived areas. Designed to Smile includes a range of elements, but at its heart is a school based supervised tooth-brushing programme using fluoride toothpaste. This is supplemented with information on healthy eating, and delivery of fissure sealants or fluoride varnish to those at high risk of decay. 2012 brought good news as there was a fall in the proportion of children with obvious decay to 41%, and more recently in 2015, survey data shows that caries prevalence is now 35%. The 13% fall in caries since 2008 does seem to fit with the period covering the introduction of Designed to Smile. So can we say the improvement is because of Designed to Smile? The best control we have is England who did not have a similar national programme in place. Over the same period England has seen falls in decay prevalence, but only half as steep as those in Wales - from 31% to 25%. The North West of England is closer to Wales in terms of baseline caries levels. There the reductions in decay prevalence at age 5 between 2008 and 2015 are from 38% to 33%. It is common to see increased inequality in health outcomes with improvement in health. In the case of currently improving tooth decay the good news is that the inequalities are not widening. Children in deprived areas of Wales are seeing as much improvement as their less deprived peers. So it seems that in terms of impact of Designed to Smile, Wales does indeed have something to smile about.
Designed to Smile
Designed to Smile is a national Oral Health Improvement programme to improve the dental health of children in Wales. It is funded by the Welsh Government and was initially launched on the 30 January 2009 in both North and South Wales as a three year pilot but has now been rolled out across Wales. The Designed to Smile Programme has two elements: A preventative programme for Nursery/Primary school children: This involves the delivery of School/Nursery based toothbrushing and fluoride varnish programmes for children aged 3-5 helping establish good habits early on. Children aged 6-11 receive a Fissure Sealant programme as well as preventative advice on how to look after their oral health. A preventative programme for children from birth to 3 years: Initially pilots are being established working with Health Visitors and a wide range of professionals who work with young children. The aim is to give good consistent advice to parents, to provide toothbrushes and paste and encourage going to the dentist.
Improving Oral Health In Care By Nigel Monaghan, Consultant in Dental Public Health, Public Health Wales In 2010/11 a large dental survey of care home residents in Wales was undertaken alongside an Office for National Statistics dental survey of adults. Over the last 2 years a number of papers have been produced in scientific journals highlighting a number of findings from these surveys. About half of current care home residents have some natural teeth, fewer than older people living in the community. Care home residents have more oral disease and more reported impacts on activities of daily life than peers in the community. They also have poorer oral hygiene which is a known risk for potentially fatal aspiration pneumonia. Despite the disease present in their mouths, care home residents have relatively simple treatment needs (examination, scaling of teeth, oral hygiene advice, simple fillings). Often, delivery of this simple care is not straightforward, because of problems with co-operation, mobility and medical complexity. Some thought needs to be given to the range of staff, skills and settings needed to provide dental care for care home residents. Similar disease experience was noted for both recent and longer term care home residents suggesting these problems existed before entering the home. A key piece of learning from the survey are two simple questions which will help identify those who might benefit from dental care. “Do you have toothache or other problems with your mouth?” highlights some of those living with impacts, but not all. Also asking “Do you often have a dry mouth?” will help to identify those more likely to be living with impacts on their daily life. These two questions are something we can all use when interacting with older people in both the community and in care homes. In both cases referral for a dental check would be appropriate. A dry mouth is to some degree associated with ageing, but it is also frequently caused by medication. If a care home resident answers “yes” to the dry mouth question then 2 actions are suggested: refer for a dental check and refer for a review of medication.
A Welsh Government funded programme: Improving Oral Health for Older People Living in Care Homes in Wales
Lisa Howells, Deputy Chief Dental Officer, Welsh Government There are about 23,000 older people living in some 700 care homes in Wales at any one time. Many residents have poor or inadequate oral health when they move to their care home, often as a result of deteriorating health and mobility during the preceding years. Many have complex needs and will be entirely dependent on others for all aspects of daily living – including brushing their teeth. Research in Wales has helped to highlight the problems and you can read one piece of research in the article “Improving Oral Health in Care Homes” by Nigel Monaghan. Mouth care is a fundamental part of health care and is particularly important for older people with other health problems which can increase their risk of oral diseases. Effective oral hygiene helps to maintain an individual’s wellbeing and dignity, and contributes to their quality of life. Most importantly oral health depends on good mouth care “day in, day out”. What happens every day in the care home is far more important than occasional visits from the dental team. Improving Oral Health for Older People Living in Care Homes in Wales (Welsh Health Circular WHC/2015/001) was issued in February 2015 with the aim of improving oral hygiene and mouth care for older people living in care homes through the development of a consistent all-Wales approach. The WHC included annual recurrent funding which is shared across 7 health boards (HBs). Local Implementation Groups have been established in each health board which bring together people from a range of organisations and professions including – senior nurses responsible for older people in the community, the dental profession, care homes or organisations such as Care Forum Wales; the local authority / authorities; and representative for older people living in care homes, for example, the Community Health Council. Some groups also include Third Sector representatives and professionals such as Occupational Therapists, Speech and Language Therapists and Dietitians. The Local Implementation Groups are required to ensure the work is delivered and implemented using recognised improvement methodologies which are aligned to 1000 Lives Service Improvement and underpin how the programme is developed and rolled out. A multi professional, multi disciplinary National Advisory Group has been established to oversee and guide the programme, and a Task and Finish group is developing all Wales documentation and teaching resources to support programme delivery. You can read more at this website.
Indirect impact of preventable dental diseases on antibiotic prescribing By Anup Karki, Consultant in Dental Public Health, Public Health Wales The latest decennial Adult Dental Health Survey (2009/10) showed that 47% adults in Wales had obvious tooth decay. Eight percent of the adults had mouth conditions requiring urgent dental care. As pointed out elsewhere within this bulletin, prevalence of tooth decay within child population and older people living in care homes is also high. Presence of tooth decay and/or ‘gum diseases’, largely preventable diseases, can result in pain and infections (e.g. dental abscess, facial swelling etc) requiring dental intervention such as tooth extraction, incise and drainage of abscess etc. Occasionally patients may also require a course of antibiotics. However, Dental Public Health work in 2009 showed that dentists prescribed 9% of all antibiotics prescribed in primary care in Wales which seemed high considering limited dental conditions where antibiotic use has been recommended. With increasing antimicrobial resistance from use and misuse of antibiotics, optimising antibiotic use in dentistry in Wales was regarded as a dental public health concern. Patients receiving antibiotics prescription only without any dental intervention may also indicate inappropriate dental care. Hence optimising antibiotic use in dentistry aligns well with other dental public health functions of improving dental healthcare and reducing the prevalence of causes of dental infections i.e. dental diseases in the population. One of the recommendations from the Dental Public Health work in 2009 was to introduce individualised prescription forms for the NHS dentists in Wales. An individualised prescription form for dentists in Wales was introduced in May 2012. A 1000 Lives antimicrobial audit for dental practitioners was also developed through joint working between the Dental Public Health Team, the Welsh Government, Cardiff University School of Dentistry and the Dental Postgraduate Deanery in 2012. In the same year, the Welsh Government also removed a perverse incentive for antibiotic prescribing within the General Dental Service contract. These multiple ‘interventions’ have led to 22% decrease in items of antibiotics prescribed by dentists in Wales (Fig 1).
Our success in reducing antibiotic prescribing in dentistry in Wales have been shared with other UK countries through the UK Chief Dental Officers’ meetings, personal communication with Dental Public Health teams within Public Health England and publications in the British Dental Journal. The national antimicrobial dental audit is still ongoing providing dental practitioners with an opportunity to reflect and improve on their prescribing practice. By April 2016, 303 dentists had completed and further 207 were participating in the audit. Other pieces of work o this area include exploration of clinical and non clinical factors associated with antibiotic prescribing in dentistry and dental consultations by general medical practitioners. A dental public health project has recently started to explore the possibility of producing accurate antibiotic prescribing profile of each individual dental practitioner in Wales. Once completed, this project should lead to development and testing of various interventions with the aim of further optimising antibiotic prescribing in dentistry.
Improving Quality Together – the Dental Practice Quality Improvement Programme By Lisa Howells, Deputy Chief Dental Officer, Welsh Government The Dental Postgraduate Section of Cardiff University has developed a Practice Quality Improvement Programme - a suite of tools to support dental practices to further improve quality and safety in dental practice, and help all dental teams with continuing postgraduate development and education. The programme is supported by Practice Development Tutors. The tools include: • In-Practice training • Practice and personal development plans • The Maturity Matrix Dentistry (a facilitated practice self assessment system) • Clinical Audit (including all Wales audits on antibiotic prescribing and cross infection control) and • The quality improvement guide for dental teams (developed jointly by the Dental Postgraduate Section and 1000 Lives Service Improvement). The Practice Quality Improvement Programme helps to identify and meet the educational needs of individuals and dental practice teams, as well as supporting them to further improve their practices, team working and patient care. Shared educational experiences provide practice teams with the principles for self-improvement and practice improvement allowing them to adapt and develop in line with national quality plans and standards.
The Chief Dental Officer’s Dental Digest The CDO for Wales publishes a Dental Digest twice a year. Aimed at all dental team members it includes a wide range of information which may also be of interest to other health care professionals. You can read the latest edition and access back issues on the Welsh Government Website.
The need for action on mouth cancer By Mary Wilson, Specialty Trainee, Dental Public Health, Public Health Wales The number of people in Wales diagnosed with oral and oropharyngeal (mouth) cancers is increasing each year, with approximately 300 people in Wales diagnosed each year. Twice as many men are diagnosed with mouth cancer than women, but the number of people affected is increasing in both sexes. The largest increase in incidence occurred in younger adult men (aged 35-44 years), by 128% in the decade up to 2013. All age groups in women have seen an increase in incidence since 2001. The largest increase of 82% occurred in the age group 65-74 years. Public Health Wales report that only 55% of people with mouth cancer live longer than five years following diagnosis. The earlier cancer is diagnosed, the less likely that treatment will be successful at prolonging life. However, 59% of people with mouth cancer (for which staging is known), are diagnosed at the most advanced stage of the disease. Risk factors for mouth cancer include smoking, chewing tobacco and drinking alcohol, and human papillomavirus (HPV) infection. People can seek advice to reduce their risk from their dentist, doctor or local pharmacy, and can contact Stop Smoking Wales for support to stop smoking. Health professionals can improve their knowledge and awareness of mouth cancer with a free online toolkit produced by Cancer Research UK and the British Dental Association. The toolkit provides information on signs and symptoms of oral cancer, an image library, case studies, examination videos and CPD quiz. Access (by clicking Yes, I am a dental professional) at: http://www.doctors.net.uk/eClientopen/CRUK/oral_cancer_toolkit_2015_open/home.html Mouth Cancer Action Month takes place in November and aims to increase the education of the risk factors and signs and symptoms of mouth cancer while encouraging everybody to discuss them with their dental professional
On The Spot This month’s ‘On The Spot’ is with Maria Morgan who is a Senior Lecturer in Dental Public Health at Cardiff University.
Where do you currently work and what is your area of expertise? I work 4 days a week as a senior lecturer in dental public health for Cardiff University (where I lead the work of the Welsh Oral Health Information Unit) and one day as a public health specialist for the dental public health team at PHW. I am a generalist public health specialist registered on the UKPHR as well as a Fellow of the Faculty of Public Health. My areas of expertise are dental epidemiology, dental and wider public health and public health nutrition.
This month’s e-bulletin spotlights Oral Health, what do you think is the most important Public Health message that should be conveyed to professionals and the public around oral health? I have two key messages which are so linked to each other I cannot prioritise them. It might sound a bit simplistic but my first key message is to remember that “you can’t cut the head off from the rest of the body”. So whatever you consume can affect the oral cavity as well as the rest of the body. Lifestyle factors such as a diet high in sugars, excessive alcohol consumption and smoking tobacco can affect oral health as much as they can affect more general health. My other main public health message would be to brush your teeth twice a day, morning and night with a fluoridated toothpaste. Delivering better oral health is a useful and a practical evidence based toolkit which provides details on concentrations of fluoride in toothpaste appropriate for children and adults and how to help children brush.
What services are available in Wales related to oral health? There are a range of services in Wales related to oral health which include a wide range of dental health professionals.
NHS dentistry is provided via hospitals, the general dental service and the community dental service. There is also private provision. Members of the dental team include dentists, hygienists, therapists, nurses, technicians and the administrators involved in supporting the service. More details about services available can be found at the Health in Wales link. The community dental service, sometimes referred to as “the salaried dental service�, has a fundamental public health role. It is involved in providing robust epidemiological data which informs planning and it delivers our national oral health promotion programme Designed to Smile.
If you were granted 3 wishes what would they be? Reduce the inequalities in oral health Ensure that no children (other than those with very special needs) undergo dental treatment via general anaesthesia The food industry and health work together to reformulate food products to reduce their sugar content and educate consumers in a fair and transparent way.
What are your personal interests? I am a people person, I love sharing time with my friends and family. They are my inspiration for my career in public health. I would like to think I am working to improve the quality of life for people living in Wales and beyond - and that includes my 15 year old daughter Rhiannon! One day when I get some more free time I want to take part in Bake Off and demonstrate that you can bake with less sugar!
The Grapevine This section of the ebulletin is dedicated to news from the network members. You can submit news on the work being undertaken in your area, write us an article, showcase an upcoming project or show off your achievements! If you would like to submit an article for the Grapevine, please email publichealth.network@wales.nhs.uk The article should be no longer than 500 words and pictures are always welcome!
Flintshire schoolchildren share their smiles after winning award from Health Board Pupils at Ysgol Gwynedd, Flint have received an award for their commitment to the national Designed to Smile programme by Betsi Cadwaladr University Health Board. The Welsh Government initiative is designed to improve the oral hygiene of primary school children by encouraging them to establish good dental health habits from an early age. As part of the scheme and in addition to home brushing, pupils are shown how to brush their teeth daily at school following clinical guidance on best practice, with appropriate fluoride toothpaste. Across North Wales, more than 400 pre-school and primary school settings (including 176 schools) participate in the Designed to Smile oral health promotion programme, involving over 21,200 children. Ysgol Gwynedd, on Prince of Wales Avenue, was the first of six schools to achieve and maintain flagship status. It participates in all aspects of the oral health promotion programme, including, whole school tooth brushing, whole school oral health screening, as well as participating with Fissure Sealant and Fluoride Varnish programmes. The Health Board’s Chairman Dr Peter Higson, together with the Director of Dental Public Health, Dr Sandra Sandham, and Dental Health Promotion Manager Marian Jones, visited Ysgol Gwynedd to present the award and to congratulate its pupils and staff on their commitment to the programme.
Dr Higson said: “It was a pleasure to visit the pupils at Ysgol Gwynedd and to see how well they were doing with the Designed to Smile programme. Their enthusiasm and attitude is fantastic and I commend the pupils and staff on their commitment in making this a routine part of the school day.” Marian Jones, said: “Ysgol Gwynedd has really taken the programme on board and is fully committed to improving the dental health of its pupils. “Jeremy Griffiths, the head teacher at the school, has done a fantastic job in supporting the rest of the staff in running the programme. “The school has been involved with Designed to Smile since it was launched in 2009, and the pupils have really got behind the programme, to the point where it’s now a normal part of the school day.” Jeremy Griffiths, Head Teacher at Ysgol Gwynedd, said: “We are proud to be involved in the Designed to Smile Programme and it has made a huge difference to the dental health and attitudes of our children. “They are not only aware of the importance of regular brushing but about the effects that too much sugar in our diet can have on their teeth and health as a whole. “The whole process takes a couple of minutes out of our day but the brushing is a quiet period in each class which helps the pupils prepare for the next session of learning.”
Preventing early childhood caries in Wales: collaborative working By Mary Wilson, Specialty Trainee, Dental Public Health, Public Health Wales The 2013-14 dental epidemiology survey in Wales found that 14.5% of three year olds had experienced dental decay, rising to 20.2% in the most deprived areas (Morgan and Monaghan, 2015). It is necessary to maximise dental health gains in the youngest possible age groups to give children the best chance at reducing their risk of dental decay throughout the life course. Using prudent health principles, Public Health Wales is working with Designed to Smile and Health Visiting teams to further improve the delivery of oral health promotion to families with babies and toddlers. Training is being provided to refresh knowledge and skills in providing oral health education, in the context of recent research into motivating factors and social norms (Trubey et al, 2015). An oral health toolkit developed for health visitors in Aneurin Bevan University Health Board (Karki and Childs, 2015) is being rolled out across Wales, with collaborative working for local adaptation. This builds on close working relationships between health visitors and dental services. The feasibility of introducing ‘Lift the Lip’, an oral health screening tool for young children, is being explored during a Churchill Fellowship funded visit to Australia. Mary Wilson from the Dental Public Health team in Public Health Wales will see first-hand how the ‘Lift the Lip’ programme can feed into developing the role of health visitors to identify children at risk and early intervention strategies to reduce dental decay. This will help build a multi-disciplinary approach to improving oral health and reducing inequalities that remain too common in children in the UK.
Back Pain Myth Busters A new campaign from the Chartered Society of Physiotherapy now aims to bust the four biggest myths to help tackle what remains the leading cause of disability and sickness absence from work. Widely-held myths about back pain are making people fear doing the very activities they need to do to help them get better, physiotherapists are warning. Studies show the importance of remaining active and continuing with exercise, including weight training where appropriate, to help overcome back pain. The myths are: - Moving will make my back pain worse - I should avoid exercise, especially weight training - A scan will show me exactly what is wrong - Pain equals damage The myths are busted in a new leaflet, online resources and a series of posters that will be displayed in physio waiting rooms across the country.
HIV and Ageing Research Have your say in the calls we make to government.
Are you aged 50 or over and living with HIV? Could you spare a couple of hours to share your experiences and opinions on growing older with HIV? Your input will help us to influence the Government and decision makers. You will be interviewed by a peer researcher from our team, all of whom are aged 50 or older and are living with HIV themselves. You will be reimbursed for all travel cost and refreshments will be provided. If you are interested in taking part please contact laura.scott@tht.org.uk or 0207 812 1636 for more information.
The HIV and sexual health charity for life
Terrence Higgins Trust is a registered charity in England and Wales (reg no. 288527) and in Scotland (SC039986). Company reg. no. 1778149. A company limited by guarantee.
Animated film to help patients quit smoking A doctor at Cardiff and Vale University Health Board (UHB) has created an animated film to help patients quit smoking before surgery. Dr Tony Funnell, an anaesthetist at University Hospital of Wales, created ‘Stop Before Your Op’ to highlight the benefits of smoking cessation. The film, in collaboration with the Local Public Health Team, uses hand-drawn images to explain that quitting can increase your chance of successful surgery and aid recovery.
Dream Big The DreamBig campaign aimed at raising aspirations in teenage girls in North Wales headed to the US Girls Olympics event held at Rhyl Leisure Centre on the 18 of August. Members of the North Wales Public Health team showed the brand new website to the girls that attended and encouraged them to become bloggers for the new site. Designed by and for young women aged 11-16 in North Wales, DreamBig is aimed at signposting help and guidance on careers, ways to build confidence, beat bullying and promote health and wellbeing.
YMCA Cardiff C-Card Scheme – Pick Up Point Training Cardiff C-Card Scheme has developed a new ‘Pick Up Point’ training course targeted at professionals working in GP surgeries, pharmacies and leisure facilities. This is in an effort to grow the numbers of accessible C-Card locations for young people across Cardiff.
Rural Regeneration Unit Team: It’s Goodbye from Us‌ Following a successful 12 years, Welsh Government funding for the Community Food Co-operatives across Wales will end on 30 September 2016. Over the last twelve months the project has primarily been focused on supporting a core number of co-ops to become more self-sustaining. The team are extremely proud that out of the core group of 108 engaged Community food co-ops and their 552 volunteers they have achieved these fantastic results:
The team are moving on to pastures new, and want to say what an absolute pleasure it has been to work with all their co-ops and key partners over the years.
News Round-Up Welcome to the News-Round-Up. Click on the headings of the news item to take you to the full news story on the Public Health Network Cymru Website.
Substance Misuse Substance Misuse Delivery Plan 2016-2018 A three year Substance Misuse Delivery Plan has been launched which sets out how the Welsh Government, Public Health Wales and other partner organisations will tackle the impact of substance misuse, including work to reduce the number of drug and alcohol-related deaths.
Physical Activity Move more. Sit less. Play together. A new infographic based on the UK physical activity guidelines for the early years has been launched. The infographic will help early year’s teachers, nursery schools, health visitors and doctors to talk about the importance of young children being active. It can also be used as a training resource.
Cardiovascular Fewer dying in Wales from heart conditions The Welsh Government’s Heart Disease Annual Report has been released which shows that there has been a reduction in the number of people dying from cardiovascular disease in Wales. The report also shows that patients are being treated more quickly and closer to home and more lives are being saved through early diagnosis of heart disease related conditions.
Health Professionals Online tool to track health of the nation An online tool containing the most current and accurate data on the health of the people of Wales has been launched by the Health Intelligence Division in Public Health Wales.
Mental Health Hafal’s new “Clic” online community for people in Wales affected by a mental illness has been launched Hafal’s new “Clic” online community was launched at an event at Castle Gardens, Swansea on 14 September. The new, bilingual online community has been developed by people with direct experience of a mental illness in partnership with Hafal and the National Centre for Mental Health, and is funded by Big Lottery Wales.
Click Here for more news on the Public Health Network Cymru website
October
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Stoptober 2016 01/10/16 -31/10/16 England Campaign
Young LGBTQ People: Making Things Perfectly Queer 04/10/16 Cardiff
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Centre for Ageing and Dementia Research: Awareness - Raising Standards Conference
Raising
05/10/16 Cardiff
SaFE seminar: What should an intervention to promote safe sex and healthy relationships in Further Education look like? 05/10/16
Cardiff University
Parenting Conference 2016 – Parenting and Family Support – developing our workforce to meet the Challenge 06/10/2016
Bulith Wells
First EU Mental Health Compass Forum 06/10/16 – 07/10/16 Luxembourg
Nursing Collaborative Meeting 07/10/16
Llandrindod Wells
Pathways to harm, pathways to protection: learning from serious and fatal child maltreatment 07/10/16 London
Two Day Sexual Health Awareness and C-Card Training 10/10/16 Cardiff
Investment in Sport and Activity. The Economic Impact of Sport 11/10/16
Manchester United Football Ground
Click Here for more events on the Public Health Network Cymru website
The Health Buzz Brush DJ Available for free on both Apple and Google Brush DJ is a brushing timer that uses a person’s own music library to help brush for a full two minutes. The website provides a video tutorial on the app’s features, along with information for patients and dental professionals. There is even a list of favourite brushing songs.
The Sugar Smart App The Sugar Smart app allows people to scan the barcode of over 75,000 everyday food or drink products and see how many 4 gram sugar cubes it contains (total sugar). They can also share a ‘sugar reveal’ with their friends and family, and find hints and tips to cut down on sugar on the Change4Life website. The Sugar Smart app is available for free from the app store and google play assessment and care planning process.
New Look Homepage for PHNC The Public Health Network Cymru website homepage has recently been updated. Let us know if you have any further suggestions for improvement.
Contact Us Publichealth.network@wales.nhs.uk Capital Quarter 2 Floor 5 Tyndall Way Cardiff CF10 4BZ www.publichealthnetwork.cymru If you have any news or events to contribute to the next edition please submit them to publichealth.network@wales.nhs.uk deadline for submission is the 3rd friday of every month.
October Edition: Spotlight on Vetrans Health